Abstract
PurposeAccording to the entrustable professional activities (EPA) for entering residency by the Association of American Medical Colleges, incoming residents are expected to independently obtain informed consent for procedures they are likely to perform. This requires residents to not only inform their patients but to ensure comprehension of that information. We assessed the communication skills demonstrated by 372 incoming pediatric interns between 2007 and 2018 at the University of Texas Health Science Center at Houston, obtaining informed consent for a lumbar puncture.MethodsDuring a simulated case in which interns were tasked with obtaining informed consent for a lumbar puncture, a standardized patient evaluated interns by rating 7 communication-based survey items using 5-point Likert scale from “poor” to “excellent.” We then converted the scale to a numerical system and calculated intern proficiency scores (sum of ratings for each resident) and average item performance (average item rating across all interns).ResultsInterns received an average rating of 21.6 per 28 maximum score, of which 227 interns (61.0%) achieved proficiency by scoring 21 or better. Notable differences were observed when comparing groups before and after EPA implementation (76.97% vs. 47.0% proficient, respectively). Item-level analysis showed that interns struggled most to conduct the encounter in a warm and friendly manner and encourage patients to ask questions (average ratings of 2.97/4 and 2.98/4, respectively). Interns excelled at treating the patient with respect and actively listening to questions (average ratings of 3.16, each). Both average intern proficiency scores and each average item ratings were significantly lower following EPA implementation (P<0.001).ConclusionInterns demonstrated moderate proficiency in communicating informed consent, though clear opportunities for improvement exist such as demonstrating warmth and encouraging questions.
Highlights
There were notable differences when comparing the proportion of proficiency scores of at least 21 before and after entrustable professional activities (EPA) implementation
Each item’s average rating among post-EPA interns was significantly lower than those of preEPA interns (Table 3). Interpretation These results reveal 2 major findings: first, there is a clear opportunity to increase the number of interns proficient at communicating informed consent, and second, efforts to improve communication should focus on demonstrating warmth and friendliness as well as encouraging questions from the patient
Overall, interns demonstrated moderate proficiency in communicating informed consent which is an EPA expected of incoming interns
Summary
A scoping review indicated a need for focused, empirical studies targeting the EPAs [6]
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